EVALUATION OF THREE CASES WITH ACUTE CORONARY SYNDROME CAUSED BY CORONARY THROMBUS

Öz

Coronary thrombus causes reduced blood flow in patients with acute myocardial infarction. Our aim was to to contribute to the understanding of the mechanisms of coronary occlusion caused by thrombus, evaluating the histopathological characteristics of thrombi in three cases. Cases were diagnosed with ST elevation type of myocardial infarction by coronary angiography. Histopathological analysis of thrombi as well as immunohistochemical staining with PTX3 (pentraxin 3, an acute phase protein) and CD68 (a cytokine released from monocyte and macrophages) were performed. Blood levels of troponin and PTX3 were also evaluated. The PTX3 immunostaining score was high in all cases but it was not consistent with its blood level. The high PTX3 staining intensity in the case with normal PTX3 blood level may be the result of rapid local release of PTX3. Case with highest PTX3 blood level had another inflammatory disease that could have driven this increase. We suggest that PTX3 and CD68 immunostainings can be used as a marker in the histopathological evaluation of coronary thrombus.

Anahtar Kelimeler

• Acute coronary syndrome
• CD68
• Coronary thrombus
• Pentraxin 3

KORONER TROMBÜSÜN NEDEN OLDUĞU AKUT KORONER SENDROMLU ÜÇ OLGUNUN DEĞERLENDİRİLMESİ

Öz

Akut miyokard infarktüsü olan hastalarda koroner trombüs, kan akımının azalmasına neden olur. Amacımız, üç olguda trombüs analizi yaparak, trombüsün neden olduğu koroner oklüzyon mekanizmalarının anlaşılmasına katkıda bulunmaktı. Olgulara koroner anjiyografi ile ST elevasyon tipi miyokard infarktüsü tanısı konuldu. Trombüslerde histopatolojik inceleme ve PTX3 (Pentraksin 3, bir akut faz proteini) ve CD68 (monosit ve makrofajlardan salınan bir sitokin) ile immünohistokimyasal boyama yapıldı. Ayrıca troponin ve PTX3 kan düzeyleri ölçüldü. PTX3 immün boyama skoru, tüm vakalarda yüksekti ve kan düzeyleri ile uyumlu değildi. PTX3 kan düzeyi normal olan vakada boyanma yoğunluğunun fazla olmasının, PTX3'ün hızlı lokal salınımı sonucu olabileceği düşünüldü. En yüksek PTX3 kan düzeyi olan vakada, bu artışı sağlayabilecek başka bir inflamatuar hastalık vardı. PTX3 ve CD68 immün boyamalarının, koroner trombüsün histopatolojik değerlendirilmesinde bir belirteç olarak kullanılabileceğini düşünüyoruz.

Anahtar Kelimeler

• Akut koroner sendrom
• CD68
• Koroner trombüs
• Pentraksin 3 Yazışma

Kaynakça

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